Статья
Инфекционный эндокардит как причина развития дисфункции клапанов сердца
Инфекционный эндокардит (ИЭ) – заболевание, сопровождающееся высокой госпитальной смертностью. Одним из основных осложнений ИЭ, требующих хирургического вмешательства, является дисфункция пораженных клапанов сердца – как нативных, так и протезных. В обзоре рассматриваются причины возникновения и течение ИЭ. В частности, рассмотрена роль сопутствующих инфекционных очагов в формировании и развитии ИЭ, описаны механизмы взаимного перехода подострой и острой клинических форм, современные принципы и методы диагностики на основе системы критериев Дьюка, а также сложности, которыми сопровождается оценка клинического статуса пациента. Подробно рассмотрены участие нормобиоты организма человека и возможности для их идентификации методом микробиологического посева и полимеразной цепной реакции. В соответствии с современными исследованиями сделан вывод о вкладе облигатно анаэробных бактерий, грибов и вирусов в развитие эндокардита. На основании анализа данных литературы представлены предположительные принципы формирования дисфункции клапанов сердца в результате метаболической активности клеток возбудителей ИЭ: к стенозу клапана может приводить вегетация, сформированная Staphylococcus aureus, а к регургитации – разрушение структуры клапана сердца под действием гиалуронидаз, коллагеназ; способность клеток возбудителей заболевания избегать ответной реакции иммунной системы человека обусловлена образованием биопленок, фибриновых вегетаций и выработкой целого ряда ферментов – цитотоксинов (стрептолизины, лейкоцидин и др.). Сделано предположение об участии медиаторов воспаления и лейкоцитарных клеток в разрушении нативной и протезной тканей вследствие недоступности возбудителей ИЭ для иммунокомпетентных клеток.
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